Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 63: First Dig Two Graves
January 17, 1991, Circleville, Ohio
"What do you think?" Kris asked as we watched CNN on Thursday morning while I ate breakfast
She'd resumed her habit of rising early with me on weekdays.
"I think I'm glad we don't turn on the TV most nights," I replied. "I'd have stayed up way too late watching the news."
"I meant about the war?"
"We all saw it coming," I replied. "When the Iraqis rejected the French proposal, it was inevitable. My concern is if Saddam fires Scud missiles at Israel, as those are clearly intended to create a wider war, and, sadly, some people are actually itching for that."
"Who? I mean, besides Saddam Hussein?"
"Protestants who believe the battle of Armageddon will usher in the end times."
"That's crazy!"
"Tell me about it! But is it any crazier to be bombing an enemy back to the Stone Age?"
"No. But your opinions don't match those of most Americans."
"Despite my objection to certain economic aspects of your politics, you and I mostly agree. No matter what the question, war is never the answer."
"No, it's not."
January 18, 1991, McKinley, Ohio
"Mike, do you have a moment?" Isabella asked when I arrived in the ED on Friday morning.
"I do."
"We can use Doctor Wernher's office."
I followed her in and shut the door behind us.
"Jessica Lake?" I asked.
"I figured you would know."
"I suggested she speak to you or Brent."
"She said you threatened to give her a bad evaluation because she disagreed with you."
"Actually, I promised to give her an accurate evaluation," I replied. "If she took that to mean a bad evaluation, it demonstrates she agrees with my assessment!"
Isabella laughed, "A Loucksian answer if there ever was one!"
"The logic is impeccable!" I declared.
"What's your side?"
"There is no side," I replied. "It's an objective observation that she has not made the necessary effort to receive more than an overall score of 4 on her evaluation."
"Barely meeting expected performance?"
"Yes. If she doesn't show signs of improvement in the next two weeks, some of her scores will be in the 'Below Expected Performance' range. She has it in her head that to be a radiologist, she does not need to know anything about primary or emergency care."
"What about your other student?" Isabella asked.
"Arjun Mehta is an average student who intends to be a primary care physician, and I believe he's well-suited for that, given his general demeanor and his attentiveness. He'll end up with a score in the 5 to 6 range and will have no trouble Matching for family medicine."
"Is there anything specific you can point to?"
"The CO poisoning patients; she didn't even know the most basic blood chemistry. Arjun, as an MS3, did know. When I addressed it with her, I also mentioned that on her upcoming surgical rotation, she wouldn't be able to skate through, because she'd be asked questions about surgical procedures. I said that if she wasn't able to answer them, it was going to negatively affect her evaluation and create trouble with the Match. Her response was to say that was not what she had heard."
"From my conversation with her, I'd say your assessment is accurate, and she has the mistaken idea that all she needs to know is radiology."
"As I explained to her, her MLE grade will suffer, and she'll have difficulty in her interviews with the clinical quiz that most Residency Boards give."
"I saw Doctor Wernher put you on the Residency Board."
"I was going to be interviewing either way, and I'm happy to help choose our new Residents. Is there anything I need to do with regard to Miss Lake?"
"No. No matter how much she whines, nobody is going to question your evaluations. You're tough but fair, which is how it should be, and you are, without question, the best teacher here. All one has to do is look at Mary Anderson to see that."
"Thanks. Anything else?"
"No. Just keep on keeping on, as they say."
"Will do."
We left the office, and my students and I began seeing patients. Everything went along as usual until I returned from my lunch break, when Dutch asked to see me. I went to his office, closed the door, and sat down.
"Jessica Lake spoke to Doctor Billings and requested to be assigned to a different Resident," Dutch said without any preliminaries.
"I'm not surprised," I replied. "She's realized she's going to receive a subpar evaluation."
"If you were Chief Resident, what would you do?"
"Deny the request," I advised. "We don't get to choose our teachers or supervisors."
"Present company included?"
"Yes, but it's a neutral statement. You know my opinion, and there is no point in rehashing it. If anything, it demonstrates why you shouldn't reassign her."
"I recall from our previous conversations that you had conflicts with several Residents and Attendings."
"I did, and I always followed the maxim that if I wanted to join the guild, I had to satisfy the other guild members, and mostly acted consistent with that principle. Mostly those turned out positive."
"This is off-the-record; besides Psych, whom?"
"Isabella and I didn't see eye-to-eye at first, but we resolved that fairly quickly. The one that was never resolved was Rosenbaum in Pedes, but that was more his objection to my faith than anything else."
"That was when you were wearing your clerical robes full-time?"
"Yes. My solution to the problem was to follow his program without complaint, which annoyed him to no end."
"The principle of telling your kids to ignore someone teasing them?" Dutch asked.
"Yes, except I actually followed it! Not with my sister, mind you, but here at the hospital."
"Do you know if Miss Lake intends to try to Match here?"
"She doesn't because we don't have an MRI. I get the distinct impression she doesn't like our Hillbilly Hospital."
"Then, in the end, she's somebody else's problem. I assume you will continue your efforts to train her and correct her thinking?"
"Of course."
"Then she's yours for another two weeks. The interview schedule for the Residency Board will be published on Monday. Three slots each morning and three each afternoon — 0900 to 1200 and 1300 to 1600. So far, we have twenty-two interviews scheduled and four applications for which we're trying to schedule interviews."
"Any local talent?"
"Only one - Len Godwin, which is a bit of an anomaly from what I hear."
"Honestly, other than Len, the only standout students I saw were ones who want to match for cardiology, surgery, trauma surgery, or, weirdly, pathology."
"That's a new one."
"I know, but this is a guy who loves puzzles and mysteries, so it's perfect. And we do need good pathologists. I'd hate to not have someone ready to fill McKnight's shoes when he retires."
"A legitimate point."
"Mine usually are," I said with a smug smile.
"On THAT note, get out of here, Loucks!"
"Getting out as ordered!" I chuckled.
I left his office and rejoined my students. At lunch, I sought out Shelly Lindsay.
"Would you do something for me?" I inquired.
"What's that?"
"Jessica Lake is an MS4 who will be on a surgical rotation starting in February. Would you assign her to Mary Anderson?"
"Is this a good assignment or a bad assignment?"
"Bad, the way you mean it. Miss Lake needs an attitude adjustment if she's going to pass the MLE and Match. Mary is the right person for the job."
"Given that we used to give you the reclamation projects, I can't object to your request. What's the problem?"
"This is between you and me, and not to be shared with Mary, as I don't want to poison the well. In fact, Mary shouldn't know that Miss Lake is a problem. She'll figure it out pretty quickly on her own. Basically, Miss Lake intends to Match for radiology, but only at a hospital with an MRI machine, and has the opinion she doesn't need to know jack about anything else."
Shelly rolled her eyes and shook her head.
"Because that's a way to score high on the MLE and pass your interview."
"I know. I tried to explain it to her, but it went in one ear and out the other. Her next step was to bitch to Isabella about me, and when that failed, she asked Kayla Billings to reassign her. Dutch Wernher and I spoke, and he's going to deny her request on my advice."
"Rosenbaum?"
"Bingo. We don't get to pick our teachers, supervisors, or patients, for that matter. You know Isabella and I got off on the wrong foot, as was the case with Dutch as well. In all three cases, it was on me to solve the problem as the junior person. It's all part of my theory of each student being responsible for their own education and training."
"OK. I'll make sure Miss Lake is assigned to Mary, and I won't say anything."
"Thank you."
January 20, 1991, Columbus, Ohio
"How have you been, Michael?" Bishop JOHN asked when I met with him after the Divine Liturgy on Sunday.
"I almost hate to say it, but things have been relatively calm. The hospital keeps me busy, of course, so it's a balancing act with family and the band."
"Have you seen Father Roman?"
"In November. My schedule changed, so I have a four-hour shift on Saturday, which will likely be the case until June. I'm permanently assigned to the Emergency Department now, and in June, I'll switch to an Emergency Medicine Residency."
"The change you mentioned and intended to discuss with Father Roman was approved?"
"It was."
"That means you will finish your training in about eighteen months, does it not?"
"It does. I'll seek my license sometime in the next year, then seek Board Certification in Emergency Medicine."
"How do your hours change?"
"If everything goes according to plan, I'll work around fifty hours each week starting in June, then after that, between forty-eight and fifty-two hours, though I'm likely to have night, weekend, and holiday shifts during my first year as an Attending."
"Then the time to discuss your future service to the church would appear to be about two years from now. How is your prison ministry?"
"Other than juggling my time, it's going well. I'm not making much progress with Frank Bush, but that hasn't deterred me. The other men are mostly responsive and regularly attend the Typika conducted by Protodeacon Ivan once a month, which I'm sure he's reported."
"He has, though he mostly does not interact with the men beyond that. According to him, they all prefer speaking with you. How will your schedule affect that?"
"I missed December, and I'll need to go on Sunday afternoons instead of Saturdays until June. After that, it'll depend on my schedule, though I have significant control over that as I'll be Chief Resident."
"A change in attitude, if I recall correctly."
"I considered the input from my mentors and did what I thought was best for patient care."
"That has always been your focus," Vladyka JOHN said. "How are you spiritually?"
"I think the best answer is 'peaceful'."
"That's a very good place to be. Is there anything you need from me?"
"Just your prayers, Vladyka."
January 28, 1991, McKinley, Ohio
On Monday, after a routine week and weekend, we had our first interviews for prospective Residents. I'd received the CVs for the first batch of fourteen we'd see during the week, spread out almost evenly over the days, which meant no more than two or three hours interviewing each day. Our first interviewee on Monday morning was Mary Kealty, a young woman who had attended Miller School of Medicine at Miami of Florida after attending Florida Atlantic University.
"Good morning, Miss Kealty," Brent Williams said. "Welcome to Moore Memorial."
"Good morning, Doctor Williams," she replied.
"I have with me Doctor Greg Casper, Doctor Isabella Mastriano, who are both Attending physicians, along with Doctor Kayla Billings, Chief Resident, and Doctor Mike Loucks, PGY2."
"Good morning, Doctor Casper, Doctor Mastriano, Doctor Billings, and Doctor Loucks."
"Mike goes by Doctor Mike," Ghost said with a friendly smile.
I was the only one wearing scrubs, and I had eschewed my medical coat as well. Dutch and I had debated it, and in the end, he'd acquiesced to my preferences.
"If you would, Miss Kealty, tell us about yourself."
She was originally from Chicago, from a large traditional Catholic family, and upon graduating from High School, she'd moved to Florida to attend college, spending four years at Florida Atlantic to complete her undergraduate degree and then attending Miller School of Medicine to earn her MD. She'd decided on medicine while a Senior in High School, and had chosen Florida because she wanted to be on her own.
She'd earned excellent grades the entire way, and during her clinical rotations had decided that the pace and excitement of the Emergency Department were what she wanted. As for applying in Ohio, it was because her fiancé, whom she'd met in Florida, was an executive with American Electric Power in Columbus.
"Doctor Mike, you have the first question," Brent said once she'd finished.
I'd discussed with Isabella and Ghost how best to proceed, and they agreed they'd ask the diagnostic and medical knowledge questions, while I probed for attitude and fit.
"Miss Kealty, what is the single most important skill for any physician?" I asked.
"Compassion," she replied.
"I agree that is supreme, but compassion is a trait, not a skill."
"Listening," she replied with a smile. "Something I failed to do properly just now."
"Why is that?"
"Every case begins with listening, either to the patient, another physician, or the paramedics. A medical student or Resident also needs to listen to their instructors and mentors if they're going to learn."
"Thank you," I said.
Brent called on the other doctors, and each asked a question, and Miss Kealty gave very good answers, admitting when she was unsure or did not know the answer. After all four of the others had their turns, it was back to me.
"What is the most interesting case in which you've participated?" I asked.
She laughed softly, "I could tell you Spring Break stories, given both my emergency medicine rotations were during that time, but I'll go with one from my Medicine Sub-I — a parasitic infection contracted on a visit to Nigeria."
"Which one was that?" I asked.
"Schistosoma haematobium," Miss Kealty replied. "They had never seen a case before."
"How was it discovered?"
"The patient presented with hematuria, and it took three days before Medicine performed the urine survey and located the eggs."
"What could have sped up the process?" I asked.
"I'm not sure anything could because on the list of differential diagnoses for hematuria, that's pretty far down the list."
"When did you know he had traveled outside the country?"
"Not until the second day."
"What lesson do you take from that experience?"
"To always ask about international travel when a patient presents."
"Thank you."
Once the other four had asked questions, it came back to me for my third and final question.
"If you had to name a hero, who would it be?" I asked.
"Elizabeth Blackwell," Miss Kealty replied.
"The first woman to receive a medical degree," I said quickly. "A solid choice."
"Doctor Mike is a showoff," Isabella interjected with a smirk.
"May I ask who yours would be?" Miss Kealty inquired.
"For medicine, Doctor William Osler; for everything else, Doctor Martin Luther King Jr."
"The father of modern medical education," Miss Kealty replied. "And the source of your first question! He said 'Listen to your patient, he is telling you the diagnosis'."
"Speaking of show-offs," I chuckled. "Very good, Miss Kealty. Thank you."
The other four asked their questions, then Miss Kealty was given a chance to ask hers.
"What is it like to be a Resident here?" she asked.
"Why don't you take that, Mike?" Brent suggested.
"I'm not sure asking the guy who suggested «Lasciate ogni speranza, voi che uscite» as our motto is a good choice!" Isabella smirked.
"'Abandon hope, all ye who exit here'?" Mary asked.
I chuckled, "Twelve years of parochial school, right?" I asked.
"Yes," she replied. "That's a riff on Dante's Inferno."
"Very good. And to correct Doctor Mastriano, my choice of motto is 'Best care anywhere'."
"M✶A✶S✶H," Miss Kealty said with a smile.
"Being a Resident here is challenging and rewarding. We're about to embark on certification to be a Level I Trauma Center, and I'm certain you'll receive a tour of the new Emergency Department before you depart today. We're not crazy like Cook County in Chicago, but we're very busy. Resident hours are limited by policy such that there are no shifts longer than twenty-four hours, no more than eighty hours in a week, and at least eight hours between shifts. You won't find that many places except in New York. The Attendings here are excellent teachers, and we have the best group of Residents you can find anywhere."
She asked a few more questions about the area, but our time was up as Gabby Martin came to escort Miss Kealty to her next session, which was her psych eval.
"Do I have a minute?" Miss Kealty asked Gabby.
"A few, if you don't need a comfort break."
"I'm fine," Miss Kealty said. "Doctor Mike, do you have a moment?"
"I do," I said.
I got up and walked over to where she was standing.
"Do you remember a girl named Rebekah Blanchard?" Miss Kealty inquired.
"I do," I replied. "Last I heard, she was in Florida managing a property for a billionaire hedge fund manager."
"Noel Spurgeon," Miss Kealty replied. "She said I should say 'hello' to you and ask you to say 'hi' to José."
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